Health insurance coverage for COVID-19 testing has evolved. Policies now vary based on the insurer, test type, and reason for testing. Understanding the current landscape requires individuals to examine their specific health plan details.
Current Landscape of COVID-19 Testing Coverage
The federal Public Health Emergency (PHE) for COVID-19 ended on May 11, 2023. During the PHE, federal law mandated that most health insurers cover COVID-19 tests without cost-sharing or network restrictions.
With the PHE’s expiration, federal mandates ended. Coverage for COVID-19 testing is now at the discretion of individual insurance plans and may involve deductibles, copayments, or coinsurance. Insurers may also impose network restrictions, requiring tests to be performed by in-network providers. Some state laws, however, may still mandate cost-free coverage for state-regulated plans.
Understanding Different Test Types and Coverage
Medically necessary laboratory-based tests, such as PCR and antigen tests ordered by a healthcare provider due to symptoms or exposure, are generally still covered by most private insurance plans. These tests may now be subject to standard cost-sharing requirements, including copays, deductibles, or coinsurance. Medicare Part B also continues to cover provider-ordered laboratory PCR and antigen tests without out-of-pocket costs.
Over-the-counter (OTC) rapid antigen tests, including at-home kits, often have varied coverage. During the PHE, private insurance plans were required to cover up to eight free OTC at-home tests per individual per month. This requirement expired with the PHE, so most private insurers are no longer obligated to provide free at-home tests, and individuals will generally need to pay for them out-of-pocket. Medicaid and the Children’s Health Insurance Program (CHIP) continue to cover both OTC and laboratory testing without cost-sharing through September 30, 2024, after which state-specific policies apply.
Tests for surveillance purposes, such as for employment, travel, or school requirements without a medical reason, are typically not covered by insurance. Individuals are responsible for the full cost. Always confirm specific coverage details with your insurance provider before obtaining a test.
Options for Uninsured Individuals
Individuals without health insurance have options for accessing COVID-19 testing at reduced or no cost. Community health centers offer testing services regardless of a person’s insurance status or ability to pay. These centers receive federal funding to provide healthcare to underserved populations.
Local public health departments are another resource, operating testing sites or directing individuals to low-cost or free facilities. These departments often maintain up-to-date information on available services. State-funded programs may also exist to support testing for uninsured residents, though availability varies by state. Check local government websites or call 211 for current information.
What to Do About Unexpected Bills
If you receive an unexpected bill for a COVID-19 test, begin by reviewing the Explanation of Benefits (EOB) document from your insurance company. This outlines what services were billed, what the insurer paid, and your remaining responsibility. The EOB can help identify if the test was denied, applied to your deductible, or processed out-of-network.
Next, contact your insurance company to understand why the bill was issued and to clarify your coverage for the specific test and service date. If the insurer states the test should have been covered, reach out to the testing provider to ensure they submitted the claim correctly. If you believe the denial is incorrect, appeal the decision with your insurance company, providing supporting documentation like medical orders or proof of medical necessity. Understanding “balance billing”—where a provider bills you for the difference between their charge and what your insurance paid—can help you navigate disputes.